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Borderline personality disorder: a spurious condition?
- richliss 3y agoYeh this paper is something else - I've never seen one written using a tone like this before. My ex-GF was textbook BPD. Finding the survivor resources was so helpful - people who have never experienced someone who has BPD simply find it hard to believe what you say happened actually happened and those resources are almost as though someone has been dating your ex-GF as the experiences are so similar. Either BPD doesn't exist and there's a grouping of consistent traits that many people have seen first hand or it does exist and either way the outcome is the same for those observing it.
- WarOnPrivacy 3y agoMarried to someone with BPD. I guess one can debate what to call her symptom group - but insinuating her challenges don't exist is beyond absurd. After 25 years I could pretty well climb into her headspace. If I lived there, I don't think I could ever find my way out.
- 0xdeadbeefbabe 3y agoHow did she get diagnosed anyway? I thought adherents to this personality deny any weakness.
- zadler 3y agoSay a bit more about the headspace
- DougN7 3y agoI have a close friend whose daughter has it. From what I understand she can’t weigh consequences out beyond about 2 minutes. Current emotional discomfort (like being slightly bored) is over the top painful. She can’t deal with “no” sometimes, like she goes so crazy the police have to be called sometimes. I read that it’s kind of like if you had no skin and thus all your nerve endings were exposed. Sitting would hurt, a breeze would hurt, sunlight and rain would hurt. But she can go from screaming and throwing punches at her parents to being their darling little daughter five minutes later as though nothing had happened. I suspect she can’t relate at all to others’ experiences - it’s just her. She seemed like a totally normal kid until puberty hit.
- 100721 3y ago[flagged]
- SpaghettiCthulu 3y agoWould "completely illogical" be better?
- J_cst 3y agoAre you serious?
- Tao3300 3y ago> Respectfully Saying that doesn't make it so.
- ganbatekudasai 3y ago> I read that it’s kind of like if you had no skin and thus all your nerve endings were exposed. That seems to be exactly right. However, it also seems that, with some intelligence and introspection, people can totally learn how to deal with that and live a normal life. It's hard for me to tell whether the symptoms actually subside, or whether they are just perfectly capable of dealing with them. From what I've been told, a big part of BPD is "internal emotional feedback loops" that become hard to break out of, but it's apparently possible to recognize them early and not build up.
- type0 3y ago> a big part of BPD is "internal emotional feedback loops" Part of it is certainly that. It's not strange that some attempt to self medicate with strong psychedelics like mescaline, I heard a few successful stories but it can also go terribly wrong.
- WhatsLeftover 3y agoShe was caught in a perpetual negative feedback loop. It wholly formed her worldview and she was dependent on it for functionality. She couldn't progress by setting any of it aside because it could never be enough to improve her perspective. And whatever space she created would be quickly overwhelmed by the adjacent bad perspectives. Progress needs trust (in the process) and trust needs progress. She couldn't generate enough of either.
- willcipriano 3y agoMy wife has it, mainly she is unable to conceptualize that she is wrong and thus never learns from experience. For example she started a lawsuit against the neighbors, that she funnels tens of thousands of dollars toward because she thought the property line was further into their yard than it actually is. She recently told me we own the entire town and made some nonsensical statements to justify that belief. I'm going to try to get the lawyer disbarred because he is clearly taking advantage of a mentally ill woman. She acts out in order to gain attention. From ruining the family finances like in the first example to engaging in affairs and luring men from the internet to appear at the house. She has made false claims against me to the police. Refuses to clean up after herself, leaving huge messes, while complaining about a single item I might leave out. She lies, a lot. She doesn't seem to understand that I don't trust her anymore after all the lies, to her that's in the past even if it was a few minutes ago. I'm stuck due to my kid and family courts bias in favor of mothers. 14 more years.
- mahesh_rm 3y agoIf you ever feel hopeless and want to catch up in a call to let it out, let me know. Been there, and was luckily able to get out because of no kids. The idea of being stuck with that person would have likely killed me, without a social net that could help in the most difficult moments.
- deleted 3y ago[deleted]
- WarOnPrivacy 3y ago> Been there, and was luckily able to get out because of no kids. We had 5 (all over 18 now). I got out of it because she started hanging with the nearby homeless community and found other guys go glom onto. Then one night, while I was asleep on the sofa, she came home and emptied out her bedroom (hoarded to the ceiling). I was one door away and never stirred. I just work up and the room was completely empty. I'm still kind of stunned by that.
- ganbatekudasai 3y ago
- eep_social 3y agoShitty headline, no one likes being told their lived experience is invalid. However, DSM V does away with the BPD diagnosis for reasons that make sense to me which is what this is about.
- jychang 3y agoYeah, the headline is very different from the article. The article isn’t arguing that BPD doesn’t exist and that the patients are faking it or something, it’s arguing that the current classification system is wrong.
- pessimizer 3y agoBorderline Personality Disorder isn't a "lived experience," it's a diagnosis. People may label you, but you are not your labels.
- drewcoo 3y ago> insinuating her challenges don't exist is beyond absurd. Luckily, nobody is doing that. The claim is that BPD is too broad. If there were separate, narrower diagnoses, we might also be able to treat them better.
- uoaei 3y agoMy pet theory is that all personality disorders are essentially ingrained responses to conditioning which could adequately be described as CPTSD, roughly categorized into the different types based on the types of trauma complexes experienced and the learned responses to them.
- atleastoptimal 3y agoThe issue with personality disorders is whether something is a positive or negative is a subjective evaluation. Homosexuality was once considered a personality disorder. We consider narcissism a personality disorder, but we also reward narcissistic tendencies when one's extreme ego matches reality. Is there a single "correct" personality that we should all strive towards?
- uoaei 3y agoI believe your question is synonymous with "is there any 'correct' response to trauma?" which is equally hard to answer. Your point about which behaviors are considered disorders (e.g. homosexuality) is also well-taken. I am primarily basing my take on DSM-5's definitions.
- WarOnPrivacy 3y ago> Is there a single "correct" personality that we should all strive towards? Functional
- uoaei 3y agoDefined very narrowly by what "functions" are expected of you. Which is of course conditioned on social expectations vis a vis (subjective) value systems which may or may not align to some notion of "correctness", even in broadly utilitarian terms.
- pessimizer 3y agoi.e. showing up to work, doing well at school, dressing properly, keeping the correct company, filial piety...
- Daishiman 3y agoThis is a BS article that's basically a clinician's pet peeves and grievances. I know three close people with a BPD diagnosis. They had both a similar constellation of personality traits and all three were first medicated with antidepressants to no avail (a common trait in BPD is that it is easy to confuse for major depression). They took BPD-specific drugs and after a few trials and errors their quality of life increased _tremendously_, and there is evidence that BPD and associated personality traits are highly inheritable. It is completely possible that a combination of adequate diet, exercise and sleep and lifestyle changes may take away these symptoms as they may possibly manifest the weird ways in which our minds and bodies react to the difficulties of modern life. But for most people that's just an option. People may debate the minutiae of the biological underpinnings and the quantification of certain classes of symptoms. But that doesn't change that I've seen people who had a monthly episode of behaving like complete trash who totally changed their lives after taking lithium or other medication.
- christkv 3y agoI've known two women who were diagnosed with BPD that later turned out to be Autism. Their doctors believe BPD traits developed due to the issues their autism had on their socialisation as kids and teens. Getting on Ritalin massively improved their and their families lives. At least in women I suspect more than a few BDP diagnosis mask autism.
- jychang 3y agoDoes Ritalin improve autism? It’s an ADHD drug.
- hirvi74 3y agoStimulants improve a lot of things -- ADHD, Depression, Binge Eating Disorder, Narcolepsy, Chronic Fatigue Syndrome, etc.. It wouldn't surprise me if stimulants improved Austism in some individuals because, if I recall correctly, I think 60%-70% of people with Autism have ADHD as well.
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- ews 3y agoMy mom is BPD, she is a text book case. And I have been in therapy for almost a decade because of her emotional abuse. As many others have said, this paper is definitely beyond absurd.
- willcipriano 3y agoMy wife has it. You can go on BPD support message boards and read my experience over and over again written by other people. The stories they tell are all nearly identical to one's I've experienced personally. It's shocking how similar the behaviors are between people who have BPD.
- mahesh_rm 3y agoMy wife had it. Not anymore. Still BPD, but not anymore wife.
- cameronh90 3y agoMy girlfriend had it. Not any more. Suicide...
- mahesh_rm 3y agoI am sorry for your loss. There's a million things to say and none of them would sound right. That could have been my way out too in many occasions, but it wasn't. Heal. There's a lot of us in this process. Feel free to hit me up if things get out of hand.
- ganbatekudasai 3y agoIt can be fixed, if the person is willing to.
- Apfel 3y agoMind if I ask you if you've got experience in this regard? It's a horrible situation to deal with for family members so I'd love to know how to escape the pain we all feel.
- golemotron 3y agoI can't find it but Scott Alexander had an essay where he laid out the hypothesis that some of the personality disorders (narcissism and BPD in particular) came about through evolutionary selection. It's notable that the prevalence varies among the sexes.
- NavinF 3y agoWas it this one? https://slatestarcodex.com/2018/12/03/book-review-evolutionary-psychopathology/ https://slatestarcodex.com/2018/12/03/book-review-evolutiona...
- smt88 3y agoMy ex is a geneticist and used to talk about how evolution rewards rape in many situations, including early homo sapiens. My point is: it doesn't matter whether narcissism or BPD are useful mating strategies. It's slightly interesting in an anthropological sense, but it has no bearing on whether they should be considered disorders and treated as best we can.
- golemotron 3y agoIt can inform treatment options. NPD, unlike trauma initiated disorders, is not something that changes over one's life.
- type0 3y agoIt is a disorder if it brings chaos into normal life. Narcissism isn't the same as NPD
- ganbatekudasai 3y agoI have close experience with not one but two people with BPD, over a long time, and before and after treatment (no medication involved). You wouldn't know they have (or "had"?) BPD. One thing I noticed is that the popular stereotypes about people with BPD (which is unpleasant stuff) appears to not be true. Or rather, I bet it is true quite often, but not a direct result of BPD. Rather, it seems to be what happens when people with BPD don't know how to deal with it. The underlying condition seems to be "emotions are really strong" and especially "internal emotional feedback loops", and if you don't know what's happening, I totally get how someone might confusingly react accordingly to what they are feeling in a bad way: Lashing out, paranoia, accusations, oscillating between thinking someone is a saint versus someone is terrible... The two people I know both have been in talk therapy (not anymore), and they are generally very introspective. Knowing what they know, they seem to be perfectly able to separate their internal tumult from reality, and appear generally pleasant at least to me. A big part seems to be to recognize the feedback loops early and breaking out of them. That was different in the now distant past, but again, I totally get how their confusion back then led to that past behavior...
- sshine 3y agoMy word for “borderline” in my family is “LARP’ing”.
- nhod 3y agoThis sentence is very telling: "It emerged over 60 years ago to describe patients on the border between neurosis and psychosis who might be amenable to treatment with psychoanalysis." What I love about this article is it makes us question the thing we all think we can't question: the validity of the diagnosis itself. What if the whole thing is wrong? What if it is this "easy" thing clinicians invented because they just got frustrated with how insanely certain patients acted when their underlying neuroses became so severe that they progressed into something closer to psychosis? What if focusing on a BPD diagnosis masks underlying conditions that are much easier to recognize and treat? What if it is just underlying disorders advanced to the Nth degree, that all somehow converge on a similar behavior set (much like psychosis), despite a differing underlying cause, and that focusing on that similar behavior set rather than on those underlying disorders is what causes BPD to be so untreatable? A BPD diagnosis is often hopeless. There are no good drugs for it, and talk therapy works poorly. Almost all the comments here on HN from people who have someone with BPD in their life reflect this reality, and how terrible BPD is. This article actually gives me hope for my sister. It gives me a new perspective on how we have been trying to help her, and why it might not be working.